1629009873 NPI number — GREATER OAKLAND VISITING NURSE ASSOCIATION, INC.

Table of content: (NPI 1629009873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629009873 NPI number — GREATER OAKLAND VISITING NURSE ASSOCIATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER OAKLAND VISITING NURSE ASSOCIATION, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629009873
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
959 W HURON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERFORD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48328-3727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-683-1770
Provider Business Mailing Address Fax Number:
248-683-1774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
959 W HURON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERFORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48328-3727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-683-1770
Provider Business Practice Location Address Fax Number:
248-683-1774
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FISHMAN
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
248-683-1770

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  237013 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251V00000X , with the licence number: 237013 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0E027 . This is a "BLUE CROSS PROVIDER NO." identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 000000004857 . This is a "CAPE INSURRANCE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: M017039 . This is a "CHAMPUS PROVIDER NO." identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 125910 . This is a "GREAT LAKES HLTH PROVID." identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5173856 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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